Hand, foot and mouth disease: Prevention and management

Hand, foot and mouth disease (HFMD) is a common viral infection that mainly affects babies and children under five years of age, although older children and adults can also develop the disease. It is usually mild and clears up on its own within seven to ten days. However, it can cause considerable discomfort, especially when painful mouth sores make eating and drinking difficult. Understanding how the disease spreads, recognising its symptoms and adopting appropriate preventive measures are important for protecting children, families and communities.

The disease is caused by viruses belonging to the enterovirus group. Coxsackievirus A16 is a common cause, although other viruses, including enterovirus A71, can also cause the illness. The disease spreads through close contact with an infected person, saliva, fluid from skin blisters, respiratory droplets released during coughing or sneezing, and contact with faeces. Infection can also occur when people touch contaminated objects and surfaces, such as toys, door handles, tables and feeding utensils, before touching their mouths, noses or eyes.

The first symptoms often include fever, sore throat, tiredness and loss of appetite. Painful sores may subsequently develop inside the mouth, on the tongue and around the gums, while a rash, sometimes accompanied by small blisters, may appear on the palms of the hands, soles of the feet and other parts of the body, including the buttocks. Despite its name, the disease does not always affect only the hands, feet and mouth. Symptoms usually appear three to six days after infection, and some people, particularly adults, may experience mild symptoms or none at all while still contributing to the spread of the virus.

Prevention

Good personal hygiene remains one of the most effective ways to prevent the spread of HFMD. Children should be taught to wash their hands thoroughly with soap and clean running water, particularly after using the toilet, changing nappies, wiping their noses and before eating or preparing food.

Parents and caregivers should supervise young children to ensure that they wash their hands properly. Alcohol-based hand sanitisers may be useful in some situations, but they should not replace handwashing with soap and water, especially when the hands are visibly dirty.

Frequently touched surfaces, toys, feeding utensils and shared play equipment should be cleaned and disinfected regularly. Children and adults should avoid sharing cups, spoons, towels and other personal items with infected people. Children who are unwell should stay away from school, nursery or childcare settings when they have a fever, feel too ill to participate in normal activities or cannot control drooling caused by mouth sores. Parents should follow local public health guidance on when children can safely return.

Teaching children to cover their mouths and noses when coughing or sneezing, dispose of used tissues properly and avoid close contact with infected people can also reduce transmission. Caregivers should wash their hands carefully after changing nappies or cleaning up bodily fluids. There is no widely available routine vaccine that protects against all the viruses responsible for HFMD, making good hygiene and environmental cleanliness essential preventive measures.

Treatment

There is no specific medicine that cures ordinary hand, foot and mouth disease because it is caused by a virus. Antibiotics are ineffective against the infection, although a healthcare professional may prescribe them if a separate bacterial infection develops.

Treatment therefore focuses on relieving symptoms, maintaining adequate fluid intake and preventing dehydration. Children should be encouraged to drink plenty of fluids, including water and other suitable drinks. Cool drinks and soft foods may be easier to swallow when mouth sores are painful, while acidic drinks, such as orange juice, and spicy or salty foods should be avoided if they worsen the discomfort.

Paracetamol may help relieve fever and pain when administered according to the child’s age, weight and the instructions on the product label or the advice of a healthcare professional. Ibuprofen may also be suitable for some children, but it should not be given to a dehydrated child. Aspirin must not be given to children unless specifically directed by a specialist. Parents should also avoid giving children un-prescribed mouth gels or sprays, as some products contain ingredients that may be unsafe for young children. A pharmacist or doctor can recommend appropriate ways to manage mouth pain and other symptoms.

Most children recover within seven to ten days without serious complications. Nevertheless, parents and caregivers should seek medical attention if a child cannot drink adequately, passes urine less frequently than usual, develops a persistent high fever, experiences worsening symptoms or appears unusually weak or drowsy. Severe headache, neck stiffness, confusion, difficulty breathing or seizures require urgent medical assessment. These warning signs should never be ignored, as serious complications, although uncommon, can occur.